Caring for your feet with a diabetes diagnosis

A new diabetes diagnosis can be overwhelming and scary. According to the American Diabetes Association, in 2021, 38.4 million Americans, or 11.6% of the population, had diabetes. Of the 38.4 million adults with diabetes, 29.7 million were diagnosed and 8.7 million were undiagnosed.

Being motivated to take charge of your health with proper education, individualized care and close follow-up, can allow you to live your best life. Working together with your primary care physician or endocrinologist, ophthalmologist, podiatrist and other members of the healthcare team can help you reach or maintain the target hemoglobin A1C, protect your eyes, protect your feet, feel your best and lower your risk for diabetes complications.

Specialists on your diabetes care team

If your diabetes care team does not include an ophthalmologist or podiatrist, it would be a good idea to ask your primary care physician for a referral to see these specialists. It is important that you have a professional to evaluate and manage your eyes and feet because waiting until there is a change in your health can be detrimental. Feeling good is important, however, there may be a problem that you may not know until it is advanced.

Going to nail shops or having a family member trim your nails or calluses is not recommended. Although nail shops may be sanitary, the concern is that you may develop a cut or wound from shaving and trimming your feet, which can take a long time to heal or become infected and place you at risk for loss of a toe or foot.

People with diabetes also are at high risk for developing neuropathy (nerve damage), which affects sensation and may be described as numbness, tingling, burning or a stinging sensation. Unfortunately, neuropathy is not reversible, which can be even more frightening. The lack of sensation may not allow a person with diabetes to notice a problem soon enough before a problem occurs.

Follow-up care is a key part of your treatment and safety. If you are unsure when a follow-up appointment is recommended, please reach out to your physician to ensure you have a plan. Even if there are no questions or concerns, having a professional evaluation may save your life. Most insurances will allow a diabetic foot exam, which includes nail trimming, callus trimming and a vascular assessment every three to six months. If you have a history of peripheral artery disease (blockage in the legs), it is even more important to have a dedicated podiatrist to manage your feet.

Some other important tips for diabetes include keeping your blood sugar close to normal by watching what and how much you eat, monitoring blood sugar, taking medicines as prescribed and getting regular exercise. Do not smoke because smoking affects blood flow and can make foot problems worse. If you need help quitting, talk to your doctor about smoking cessation programs and medicines. These can increase your chances of quitting for good. Control your cholesterol. Eat a diet that is low in fat. High fat intake can cause fat to build up in your blood vessels and decrease blood flow.

Care for your feet

• Inspect your feet daily. Look for areas of redness or tenderness, which may signal pressure build up, or the beginning of a foot abscess or wound. Pay close attention for blisters, cuts, cracks or sores. With diabetes, your vision may be affected, and you may not be able to notice a major problem with your feet. It may be a good idea to use a mirror to check the bottom of your feet and have a family member check your feet daily (top, bottom and in between toes) to note a new or troubling concern.
• Wash your feet every day. Use warm (not hot or cold) water. Check the water temperature with your wrists or other part of your body, not your feet. Dry your feet well. Pat them dry. Do not rub the skin on your feet too hard. Dry well between your toes. If the skin on your feet stays moist, bacteria or a fungus can grow, which can lead to infection.
• Keep your skin moisturized. Use moisturizing skin cream to keep the skin on your feet soft and prevent calluses and cracks. Creams are preferred over lotion, because they retain more moisture than lotions. Do not put the cream between your toes and stop using any cream that causes a rash.
• Do not try to remove corns or calluses. Leave them for your podiatrist to trim. You may break the skin and create an ulceration or wound.
• Never go barefoot. You can step on a pin, piece of glass or a foreign body that can penetrate the skin and can lead to an abscess. Even if your sensation is normal, having diabetes makes wounds heal slowly and places you at risk for a bad infection that may not heal and can lead to an amputation.
• Do not attempt to trim your own toenails. If your nails are getting long, thick or painful, use a nail file to file your toenails straight across, smoothing the edges and preventing ingrown toenails.
• Do not attempt to remove an ingrown toenail on your own. It is not recommended to use any tools to pick or probe at your nails or feet. Do not go to a nail shop to remove or treat long nails, ingrown nails, corns or calluses.
• Wear white socks. This will allow you to notice any drainage, bleeding or other concerns from your feet sooner than if you wore a non-white sock. You should always wear socks. The seams and threading from your shoes can rub against your skin and can lead to an ulceration or wound.
• Look inside your shoes prior to putting them on. Remove pebbles or debris, and do not wear them if the lining is torn, which could cause blisters or ulcerations.
• Wear shoes with inserts. Your podiatrist will prescribe custom diabetic shoes with inserts, tailored to fit your foot best. This will allow support to bony areas and reduce pressure that regular shoe gear may create, and they have a wider toe box to prevent compression of toes and blistering on the feet. While you are waiting for prescription diabetic shoes or an evaluation, or if you choose to wear a different shoe for an event, choose wide, toe box shoes.
• Always get early treatment for foot problems. A minor irritation can lead to a major problem if not properly cared for early. Do not attempt to doctor any problems on your own, buy over-the-counter products or rely on home remedies or on Google for answers.
• Do not wait for a follow-up visit when there is a concern. It is always best to be on the safer side to prevent major problems. If you have not been able to contact your physician’s office, go to an urgent care for an evaluation.

Call your doctor now or seek immediate medical care if:

• You have a new pressure area, redness, cracks in the skin, new or more drainage for a current ulcer/wound that is being managed, new or more swelling, pain, an ulcer or break in the skin, fever, chills or any concerns about a new or worsening wound or infection. Try to clean the area with saline (over the counter) and cover it with gauze and tape until you can be evaluated. Do not leave the area open. Do not allow your feet to get wet, soak in water or bathe during this time. Most people resort to peroxide, which is not recommended for most foot wounds and can cause more harm than help.
• You have blue or black areas, which can mean bruising or blood flow problems.
• You notice a change in color or the temperature of the skin on your legs or feet.
• You have new numbness or tingling in your feet.
• You have questions or concerns about your foot health.

If you would like an evaluation by a trusted team of podiatrists, please call Baylor Medicine Vascular Health at 713-798-5700.

By Elexis Williams, NP-C, lead podiatry nurse practitioner in the Division of Vascular Surgery